The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery
Introduction Neurologic complications after complex adult spinal deformity (ASD) surgery are important, yet outcomes are heterogeneously reported, and long-term follow-up of actual lower extremity motor function is unknown. Objective To prospectively evaluate lower extremity motor function scores (L...
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| Veröffentlicht in: | European spine journal 2021-11, Vol.30 (11), p.3243-3254 |
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| creator | Lenke, Lawrence G. Zuckerman, Scott L. Cerpa, Meghan Shaffrey, Christopher I. Carreon, Leah Y. Cheung, Kenneth M. C. Kelly, Michael P. Fehlings, Michael G. Ames, Christopher P. Boachie-Adjei, Oheneba Dekutoski, Mark B. Kebaish, Khaled M. Lewis, Stephen J. Matsuyama, Yukihiro Pellisé, Ferran Qiu, Yong Schwab, Frank J. Smith, Justin S. |
| description | Introduction
Neurologic complications after complex adult spinal deformity (ASD) surgery are important, yet outcomes are heterogeneously reported, and long-term follow-up of actual lower extremity motor function is unknown.
Objective
To prospectively evaluate lower extremity motor function scores (LEMS) before and at 5 years after surgical correction of complex ASD.
Design
Retrospective analysis of a prospective, multicenter, international observational study.
Methods
The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers around the world. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital or revision deformity and/or 3-column osteotomy. Among patients with 5-year follow-up, comparisons of LEMS to baseline and within each follow-up period were made via documented neurologic exams on each patient.
Results
Seventy-seven (28.3%) patients had 5-year follow-up. Among these 77 patients with 5-year follow-up, rates of postoperative LEMS deterioration were: 14.3% hospital discharge, 10.7% at 6 weeks, 6.5% at 6 months, 9.5% at 2 years and 9.3% at 5 years postoperative. During the 2–5 year window, while mean LEMS did not change significantly (−0.5,
p
= 0.442), eight (11.1%) patients deteriorated (of which 3 were ≥ 4 motor points), and six (8.3%) patients improved (of which 2 were ≥ 4 points). Of the 14 neurologic complications, four (28.6%) were surgery-related, three of which required reoperation. While mean LEMS were not impacted in patients with a
major
surgery-related complication, mean LEMS were significantly lower in patients with
neurologic
surgery-related complications at discharge (
p
= 0.041) and 6 months (
p
= 0.008) between the two groups as well as the change from baseline to 5 years (
p
= 0.041).
Conclusions
In 77 patients undergoing complex ASD surgery with 5-year follow-up, while mean LEMS did not change from 2 to 5 years, subtle neurologic changes occurred in approximately 1 in 5 patients (11.1% deteriorated; 8.3% improved). Major surgery-related complication did not result in decreased LEMS; however, those with neurologic surgery-related complications continued to have decreased lower extremity motor function at 5 years postoperative. These results underscore the importance of long-term follow-up to 5 years, using individual motor scores rather than group averages, and comparing outcomes to both baseline and last follow-up. |
| doi_str_mv | 10.1007/s00586-021-06969-z |
| format | Article |
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Neurologic complications after complex adult spinal deformity (ASD) surgery are important, yet outcomes are heterogeneously reported, and long-term follow-up of actual lower extremity motor function is unknown.
Objective
To prospectively evaluate lower extremity motor function scores (LEMS) before and at 5 years after surgical correction of complex ASD.
Design
Retrospective analysis of a prospective, multicenter, international observational study.
Methods
The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers around the world. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital or revision deformity and/or 3-column osteotomy. Among patients with 5-year follow-up, comparisons of LEMS to baseline and within each follow-up period were made via documented neurologic exams on each patient.
Results
Seventy-seven (28.3%) patients had 5-year follow-up. Among these 77 patients with 5-year follow-up, rates of postoperative LEMS deterioration were: 14.3% hospital discharge, 10.7% at 6 weeks, 6.5% at 6 months, 9.5% at 2 years and 9.3% at 5 years postoperative. During the 2–5 year window, while mean LEMS did not change significantly (−0.5,
p
= 0.442), eight (11.1%) patients deteriorated (of which 3 were ≥ 4 motor points), and six (8.3%) patients improved (of which 2 were ≥ 4 points). Of the 14 neurologic complications, four (28.6%) were surgery-related, three of which required reoperation. While mean LEMS were not impacted in patients with a
major
surgery-related complication, mean LEMS were significantly lower in patients with
neurologic
surgery-related complications at discharge (
p
= 0.041) and 6 months (
p
= 0.008) between the two groups as well as the change from baseline to 5 years (
p
= 0.041).
Conclusions
In 77 patients undergoing complex ASD surgery with 5-year follow-up, while mean LEMS did not change from 2 to 5 years, subtle neurologic changes occurred in approximately 1 in 5 patients (11.1% deteriorated; 8.3% improved). Major surgery-related complication did not result in decreased LEMS; however, those with neurologic surgery-related complications continued to have decreased lower extremity motor function at 5 years postoperative. These results underscore the importance of long-term follow-up to 5 years, using individual motor scores rather than group averages, and comparing outcomes to both baseline and last follow-up.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-021-06969-z</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Medicine ; Medicine & Public Health ; Neurological complications ; Neurosurgery ; Original Article ; Osteotomy ; Patients ; Surgery ; Surgical Orthopedics</subject><ispartof>European spine journal, 2021-11, Vol.30 (11), p.3243-3254</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-cafa53377e3ddc580529eb8c7c80e59afcdadf3135344ee2f5dfe2a0109541fe3</citedby><cites>FETCH-LOGICAL-c352t-cafa53377e3ddc580529eb8c7c80e59afcdadf3135344ee2f5dfe2a0109541fe3</cites><orcidid>0000-0002-5595-4958</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-021-06969-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-021-06969-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids></links><search><creatorcontrib>Lenke, Lawrence G.</creatorcontrib><creatorcontrib>Zuckerman, Scott L.</creatorcontrib><creatorcontrib>Cerpa, Meghan</creatorcontrib><creatorcontrib>Shaffrey, Christopher I.</creatorcontrib><creatorcontrib>Carreon, Leah Y.</creatorcontrib><creatorcontrib>Cheung, Kenneth M. C.</creatorcontrib><creatorcontrib>Kelly, Michael P.</creatorcontrib><creatorcontrib>Fehlings, Michael G.</creatorcontrib><creatorcontrib>Ames, Christopher P.</creatorcontrib><creatorcontrib>Boachie-Adjei, Oheneba</creatorcontrib><creatorcontrib>Dekutoski, Mark B.</creatorcontrib><creatorcontrib>Kebaish, Khaled M.</creatorcontrib><creatorcontrib>Lewis, Stephen J.</creatorcontrib><creatorcontrib>Matsuyama, Yukihiro</creatorcontrib><creatorcontrib>Pellisé, Ferran</creatorcontrib><creatorcontrib>Qiu, Yong</creatorcontrib><creatorcontrib>Schwab, Frank J.</creatorcontrib><creatorcontrib>Smith, Justin S.</creatorcontrib><creatorcontrib>AO Spine Knowledge Forum Deformity and SRS Scoli-RISK-1 Study Group</creatorcontrib><title>The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><description>Introduction
Neurologic complications after complex adult spinal deformity (ASD) surgery are important, yet outcomes are heterogeneously reported, and long-term follow-up of actual lower extremity motor function is unknown.
Objective
To prospectively evaluate lower extremity motor function scores (LEMS) before and at 5 years after surgical correction of complex ASD.
Design
Retrospective analysis of a prospective, multicenter, international observational study.
Methods
The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers around the world. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital or revision deformity and/or 3-column osteotomy. Among patients with 5-year follow-up, comparisons of LEMS to baseline and within each follow-up period were made via documented neurologic exams on each patient.
Results
Seventy-seven (28.3%) patients had 5-year follow-up. Among these 77 patients with 5-year follow-up, rates of postoperative LEMS deterioration were: 14.3% hospital discharge, 10.7% at 6 weeks, 6.5% at 6 months, 9.5% at 2 years and 9.3% at 5 years postoperative. During the 2–5 year window, while mean LEMS did not change significantly (−0.5,
p
= 0.442), eight (11.1%) patients deteriorated (of which 3 were ≥ 4 motor points), and six (8.3%) patients improved (of which 2 were ≥ 4 points). Of the 14 neurologic complications, four (28.6%) were surgery-related, three of which required reoperation. While mean LEMS were not impacted in patients with a
major
surgery-related complication, mean LEMS were significantly lower in patients with
neurologic
surgery-related complications at discharge (
p
= 0.041) and 6 months (
p
= 0.008) between the two groups as well as the change from baseline to 5 years (
p
= 0.041).
Conclusions
In 77 patients undergoing complex ASD surgery with 5-year follow-up, while mean LEMS did not change from 2 to 5 years, subtle neurologic changes occurred in approximately 1 in 5 patients (11.1% deteriorated; 8.3% improved). Major surgery-related complication did not result in decreased LEMS; however, those with neurologic surgery-related complications continued to have decreased lower extremity motor function at 5 years postoperative. These results underscore the importance of long-term follow-up to 5 years, using individual motor scores rather than group averages, and comparing outcomes to both baseline and last follow-up.</description><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurological complications</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Osteotomy</subject><subject>Patients</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kcFq3DAQQEVIoZttf6AnQS69qB1JlmwdS0jSpQuFZnsWijxKHGxrK9lkN18fZbcQyCGnubw3zPAI-cLhGweov2cA1WgGgjPQRhv2dEIWvJKCgZHilCzAVMB0zc1HcpbzAwBXBvSCxM090hsf-479Wd38opwmzHM_ZRoD7eMjJoq7KeHQTXs6xCkmGubRT10cqaJ7dClTF6aC-Thse9xR1xad5m03up62GGI6uHlOd5j2n8iH4PqMn__PJfl7dbm5-MnWv69XFz_WzEslJuZdcErKukbZtl41oITB28bXvgFUxgXfujZILpWsKkQRVBtQOOBgVMUDyiX5ety7TfHfjHmyQ5c99r0bMc7ZCqW10FIAFPT8DfoQ51Suf6EazU3VNLJQ4kj5FHNOGOw2dYNLe8vBvjSwxwa2NLCHBvapSPIo5QKP5f_X1e9Yz6Twi9U</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Lenke, Lawrence G.</creator><creator>Zuckerman, Scott L.</creator><creator>Cerpa, Meghan</creator><creator>Shaffrey, Christopher I.</creator><creator>Carreon, Leah Y.</creator><creator>Cheung, Kenneth M. C.</creator><creator>Kelly, Michael P.</creator><creator>Fehlings, Michael G.</creator><creator>Ames, Christopher P.</creator><creator>Boachie-Adjei, Oheneba</creator><creator>Dekutoski, Mark B.</creator><creator>Kebaish, Khaled M.</creator><creator>Lewis, Stephen J.</creator><creator>Matsuyama, Yukihiro</creator><creator>Pellisé, Ferran</creator><creator>Qiu, Yong</creator><creator>Schwab, Frank J.</creator><creator>Smith, Justin S.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5595-4958</orcidid></search><sort><creationdate>20211101</creationdate><title>The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery</title><author>Lenke, Lawrence G. ; Zuckerman, Scott L. ; Cerpa, Meghan ; Shaffrey, Christopher I. ; Carreon, Leah Y. ; Cheung, Kenneth M. C. ; Kelly, Michael P. ; Fehlings, Michael G. ; Ames, Christopher P. ; Boachie-Adjei, Oheneba ; Dekutoski, Mark B. ; Kebaish, Khaled M. ; Lewis, Stephen J. ; Matsuyama, Yukihiro ; Pellisé, Ferran ; Qiu, Yong ; Schwab, Frank J. ; Smith, Justin S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-cafa53377e3ddc580529eb8c7c80e59afcdadf3135344ee2f5dfe2a0109541fe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurological complications</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Osteotomy</topic><topic>Patients</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lenke, Lawrence G.</creatorcontrib><creatorcontrib>Zuckerman, Scott L.</creatorcontrib><creatorcontrib>Cerpa, Meghan</creatorcontrib><creatorcontrib>Shaffrey, Christopher I.</creatorcontrib><creatorcontrib>Carreon, Leah Y.</creatorcontrib><creatorcontrib>Cheung, Kenneth M. C.</creatorcontrib><creatorcontrib>Kelly, Michael P.</creatorcontrib><creatorcontrib>Fehlings, Michael G.</creatorcontrib><creatorcontrib>Ames, Christopher P.</creatorcontrib><creatorcontrib>Boachie-Adjei, Oheneba</creatorcontrib><creatorcontrib>Dekutoski, Mark B.</creatorcontrib><creatorcontrib>Kebaish, Khaled M.</creatorcontrib><creatorcontrib>Lewis, Stephen J.</creatorcontrib><creatorcontrib>Matsuyama, Yukihiro</creatorcontrib><creatorcontrib>Pellisé, Ferran</creatorcontrib><creatorcontrib>Qiu, Yong</creatorcontrib><creatorcontrib>Schwab, Frank J.</creatorcontrib><creatorcontrib>Smith, Justin S.</creatorcontrib><creatorcontrib>AO Spine Knowledge Forum Deformity and SRS Scoli-RISK-1 Study Group</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lenke, Lawrence G.</au><au>Zuckerman, Scott L.</au><au>Cerpa, Meghan</au><au>Shaffrey, Christopher I.</au><au>Carreon, Leah Y.</au><au>Cheung, Kenneth M. C.</au><au>Kelly, Michael P.</au><au>Fehlings, Michael G.</au><au>Ames, Christopher P.</au><au>Boachie-Adjei, Oheneba</au><au>Dekutoski, Mark B.</au><au>Kebaish, Khaled M.</au><au>Lewis, Stephen J.</au><au>Matsuyama, Yukihiro</au><au>Pellisé, Ferran</au><au>Qiu, Yong</au><au>Schwab, Frank J.</au><au>Smith, Justin S.</au><aucorp>AO Spine Knowledge Forum Deformity and SRS Scoli-RISK-1 Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><date>2021-11-01</date><risdate>2021</risdate><volume>30</volume><issue>11</issue><spage>3243</spage><epage>3254</epage><pages>3243-3254</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>Introduction
Neurologic complications after complex adult spinal deformity (ASD) surgery are important, yet outcomes are heterogeneously reported, and long-term follow-up of actual lower extremity motor function is unknown.
Objective
To prospectively evaluate lower extremity motor function scores (LEMS) before and at 5 years after surgical correction of complex ASD.
Design
Retrospective analysis of a prospective, multicenter, international observational study.
Methods
The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers around the world. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital or revision deformity and/or 3-column osteotomy. Among patients with 5-year follow-up, comparisons of LEMS to baseline and within each follow-up period were made via documented neurologic exams on each patient.
Results
Seventy-seven (28.3%) patients had 5-year follow-up. Among these 77 patients with 5-year follow-up, rates of postoperative LEMS deterioration were: 14.3% hospital discharge, 10.7% at 6 weeks, 6.5% at 6 months, 9.5% at 2 years and 9.3% at 5 years postoperative. During the 2–5 year window, while mean LEMS did not change significantly (−0.5,
p
= 0.442), eight (11.1%) patients deteriorated (of which 3 were ≥ 4 motor points), and six (8.3%) patients improved (of which 2 were ≥ 4 points). Of the 14 neurologic complications, four (28.6%) were surgery-related, three of which required reoperation. While mean LEMS were not impacted in patients with a
major
surgery-related complication, mean LEMS were significantly lower in patients with
neurologic
surgery-related complications at discharge (
p
= 0.041) and 6 months (
p
= 0.008) between the two groups as well as the change from baseline to 5 years (
p
= 0.041).
Conclusions
In 77 patients undergoing complex ASD surgery with 5-year follow-up, while mean LEMS did not change from 2 to 5 years, subtle neurologic changes occurred in approximately 1 in 5 patients (11.1% deteriorated; 8.3% improved). Major surgery-related complication did not result in decreased LEMS; however, those with neurologic surgery-related complications continued to have decreased lower extremity motor function at 5 years postoperative. These results underscore the importance of long-term follow-up to 5 years, using individual motor scores rather than group averages, and comparing outcomes to both baseline and last follow-up.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00586-021-06969-z</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-5595-4958</orcidid></addata></record> |
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| ispartof | European spine journal, 2021-11, Vol.30 (11), p.3243-3254 |
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| language | eng |
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| source | SpringerLink Journals |
| subjects | Medicine Medicine & Public Health Neurological complications Neurosurgery Original Article Osteotomy Patients Surgery Surgical Orthopedics |
| title | The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery |
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